Booby Traps Series: Attack of the giant bulb syringe.

My doula once attended a training in which the presenter shoved a giant bulb syringe in the faces of the participants, and then asked, “feel like eating?” Her point, if it isn’t obvious: It’s not fun to be suctioned right after birth, and it can interfere with your desire to eat.

Obviously, suctioning is sometimes necessary – for resuscitation in the most extreme example. Linda Smith, in The Impact of Birthing Practices on Breastfeeding, notes that “babies born by cesarean section usually require considerable suctioning, because the oropharyngeal mucus is not squeezed out as it is during vaginal birth.”*

But suctioning an otherwise healthy, vigorous newborn? Research shows that 1) there are no demonstrated benefits to routine suctioning (randomized controlled trials have shown no difference), and 2) routine suctioning can cause breastfeeding problems.

Linda Smith cites research showing several ways in which this causes problems for breastfeeding:

Mispatterned tongue movement: “The tongue muscle group can be mispatterned by early superstimuli such as deep or repeated suctioning.”

Defensive tongue position: “Physical irritation of the posterior palate creates a reflex guarding of the airway by the tongue…This is exactly the opposite of the anterior-to-posterior tongue peristaltis needed for breastfeeding.”

Pain, possibly leading to aversion to feeding: “Suctioning a vigorous newborn (except as needed for resuscitation) can cause physical damage to the oropharynx, causing pain during feeding attempts.”

The evidence is strong enough that the American Academy of Pediatrics makes a point of discouraging suctioning in its breastfeeding policy, recommending that physicians: “avoid procedures that may interfere with breastfeeding or that may traumatize the infant, including unnecessary, excessive, and over-vigorous suctioning of the oral cavity, esophagus, and airways to avoid oropharyngeal mucosal injury that may lead to aversive feeding behavior.”

Nevertheless, suctioning healthy, vigorous newborns appears to be very common. If you do not want your healthy, vigorous baby suctioned, we encourage you to discuss this with your care providers before your birth.

Was your baby suctioned? For good reason or because it’s just “what they do?” Do you think it had any impact on your breastfeeding experience?

Reader Interactions

Comments

Wow. Both of mine were, and I’ll tell you of all the things I was thinking about having happen/not happen, this wasn’t one of them. I hadn’t even considered this! *sigh* Yet another situation of, “Leave it ALONE!”

I had a midwife and was planning to have my daughter delivered to my chest, but the medical staff said that wasn’t possible when they found meconium in my water. They told me that they needed to deeply suction her. She ate fine after that and we’re still going strong with breastfeeding at 13 months, so it didn’t have too big an impact, obviously. My morale (after expecting an intervention-free birth, only to have her cord cut and whisked away) was the only thing that suffered. Does anyone know if it was necessary? My daughter and I ended up having no complications, and I’m told she didn’t aspirate meconium.

When there is meconium in the amniotic fluid, it is necessary to “Whisk baby off” to be sure that she hasn’t aspirated. Medical professionals are unable to determine this until after baby is deep suctioned (not with a bulb syringe but with wall suction). Glad to hear that she didn’t aspirate and that it didn’t affect nursing!

When there is meconium staining of the liquor it is ‘standard practice’ to cut the cord and suction. Only, meconium aspiration syndrome is not caused simply by having meconium in the waters. This is also related to intrapartum hypoxia where the baby may gasp etc
By cutting the cord the care givers create hypoxia – & it can also risk ‘under-perfusion’ of the lungs which can cause respiratory distress syndrome. The hypoxia and suctioning can cause the neonate to gasp, thus creating the conditions for MAS that may not have occurred otherwise.
“Wait a minute” – let the baby stay below the mother in a safe position – allow the ‘respiratory blood volume’ in the placenta return to the baby and perfuse the pulmonary structures and clear liquid out of the lungs – allow the baby to be well oxygenated with normal level of red blood cells for oxygen transport throughout the body – in the event of thick meconium, assist the baby with suctioning/ deep suctioning as required while baby safely oxygenated by placental circulation.

No, it is not always necessary. NRP guidelines are the babies born with meconium stained waters do NOT need to be suctioned unless they are born and are not “vigorous”, which means giving them a chance to breath on their own. Suctioning can also easily be done without cutting the cord, and can be done right next to you.

Gosh, this is just another one of those, “if I could go back I would do it differently moments”! My son was suctioned, however I don’t think it made a difference but I’ve got nothing to compare to being he is my only child. He is now 10 months and is EBF. Thanks for this info!

My first two babies were suctioned because both had passed merconium. In their case suctioning was necessary because the baby could inhale or swallow the poop and that can lead to serious complications and a trip to the NICU. My first ended up still spending a short time in the NICU because even though he was suctioned he had swallowed the poo and it caused stomach upset that interfered with his feeding. Thankfully he hadn’t inhaled it and dodged that bullet. If a baby inhales the poop it can block the airways because it’s so sticky and gooey.http://kidshealth.org/parent/medical/lungs/meconium.html# Before he started gurgling the poop and crying like his stomach hurt, he was happily nursing no problem. My second had more latch problems from the start probably because he was a C-section baby and had a LOT of fluid left inside. Which is why I’m trying for a vbac with this baby.

Just copying and pasting Kate’s perfect and ‘evidence based’ answer that she posted for another mum. By cutting the cord and suctioning, inexperienced birthworkers actually cause the problem they say they are trying to avoid.

“When there is meconium staining of the liquor it is ‘standard practice’ to cut the cord and suction. Only, meconium aspiration syndrome is not caused simply by having meconium in the waters. This is also related to intrapartum hypoxia where the baby may gasp etc
By cutting the cord the care givers create hypoxia – & it can also risk ‘under-perfusion’ of the lungs which can cause respiratory distress syndrome. The hypoxia and suctioning can cause the neonate to gasp, thus creating the conditions for MAS that may not have occurred otherwise.
“Wait a minute” – let the baby stay below the mother in a safe position – allow the ‘respiratory blood volume’ in the placenta return to the baby and perfuse the pulmonary structures and clear liquid out of the lungs – allow the baby to be well oxygenated with normal level of red blood cells for oxygen transport throughout the body – in the event of thick meconium, assist the baby with suctioning/ deep suctioning as required while baby safely oxygenated by placental circulation.”

Wow! My little one was not suctioned (born in a birth center with midwife) but I had no idea it could be so damaging! I am glad I read this so I can prevent it from happening to my future children who will likely be born in hospital.

My first was suctioned, no problems with latching. My second was not suctioned and, he had nipple aversion. It would take several attempts, and at least 5 minutes to get him latched the first week or so. Both were vag delivery. It’s funny, the one I had less intervention with, is the one I have more problems with. I guess, like the old saying goes, “every baby’s different”

My first 2 were suctioned cause I didn’t know better. My third was as well, but not by my choice. I told the nurse I didn’t want him suctioned and she laughed at me.. Then after he was born she made it a point to tell much just how much they’d suctioned out of him.

It’d funny you say this because they used the bulb on my first child. My second child did not get it, both natural births. No cutting no medicine. The thing is my son has some fluid get in his airways and at 2 weeks old we found out he had pneumonia. He was hospitalized 4 times before he was a year old. If they don’t suction the baby out and it gets an infection, their immunity levels drop and they will constantly catch things because they got so sick at a young age. I firmly believe if they had done the bulb I would not be standing in a doctors office today being told that my sons immune system still hasn’t fully come back at 16 months old and being put on three different medications.

My daughter also passed meconium and also was whisked away (we had a midwife too). She did not aspirate any thank goodness but she did develop oral aversion and refused to nurse the first two days. Nursing her has been the hardest (yet most rewarding) thing I’ve done. I am glad for that, because her birth unfortunately does not get this top honor because of the uncontrollable aspects (the meconium, the whisking away, are two major parts of that). Obviously I wish they didn’t suction her (the pics my husband took show what they did – it looks awful) but hindsight is 20/20 – I would have wanted them to had she aspirated meconium….

Yes – I think they had to suction because there was meconium (but not aspirated thankfully). It was my second child and despite what appeared to be a great latch, his tongue movement wasn’t right and my nipples got more and more sore over the first two days. Raw, scabbed… ouch! I stopped for a few days, and pumped what I could, supplemented with formula, and then went back to feeding. Things were still sore but not nearly as bad, and after six weeks the pain was mostly gone. It was very tempting to give up, so I would have been really upset if the suctioning was just ‘standard’, without a good reason… I don’t believe that it was standard though, so I’m not too upset. Just wish I could have avoided that pain, and I can see why so many other moms would give up if their babies were nusing poorly because of standard suctioning…

my first was suctioned excessively- for an hour and a half. half hour by reg nurses, hour by NICU. there was no reason. no meconium. she had swallowed a little fluid but when i had her chart reviewed the person said it was extremely excessive. on the flip side, she was congested in her nose and i had a nurse say NOT to suction her nose out and i believe she actually needed to have had that done. she wasn’t able to breathe at the breast.
so, between the hour and a half gig right after birth on top of an awful nurse and my own excessive IV fluids, yes- our breastfeeding efforts were derailed. it was awful.

Routine suctioning of babies solely based on the presence of meconium is no longer evidence-based. New guidelines recommend suctioning only if there is meconium *and* the baby is not vigorous. Here’s more info for those who are interested: http://emedicine.medscape.com/article/1413467-overview

Mine was deep-suctioned (due to light meconium staining, although he was breathing fine) and showed no interest in nursing … pretty much ever. The hospital LC got him to nurse 12 hours after birth with the help of a nipple shield, which caused more problems and took me 10 weeks to wean him off of. Two weeks later he started the first of many nursing strikes. He has never had a great latch either. We’ve had a really rocky nursing relationship, and I’m really hoping for better next time! Next time, no suctioning unless there’s a really clear indication for it … and I will insist on holding my baby RIGHT AWAY. (Since I’m having a homebirth, I don’t think this will be a problem!)

I was reading recently on Gentle Birth that there was a study about suctioning meconium babies. Suctioning didn’t seem to have any effect on whether or not the babies developed pneumonia — but it *did* cause increased blood pressure and a risk of bleeding into the brain. So I don’t think I would want it done at all, though I’d discuss it with my caregiver before the birth.

My son was suctioned for meconium. Because of it, he wouldn’t breastfeed correctly and gummed me instead of using his tongue. If I hadn’t been so gung-ho about breastfeeding, I’d have given up at day 5 when my nipples were cracked and bleeding. It took us 6-8 weeks to get him latching and sucking right, and now he’s an expert nurser at 8 months. Thank God for lactation consultants!

My c-section twins were suctioned. It didn’t seem to affect my larger (6 lb, 8 oz), first-born daughter but it really affected my much smaller (3 lb, 14 oz) son and it took us a while to realize he had adopted the “defensive tongue position” discussed in this article. Not only did he have a hard time breastfeeding (didn’t get to “exclusive” with him until almost 12 weeks old), but he had a hard time taking a bottle — you almost had to trick him into accepting any sort of nipple. Luckily, he became an enthusiastic breastfeeder (though he remained very small), and both my children nursed till 19 months. He was actually the last to wean!